Transcatheter arterial embolization of the pelvis has been performed for over 20 years in the treatment of pelvic trauma and post-partum hemorrhage. Previously it has been used as a neoadjuvant therapy prior to surgical myomectomy to minimize blood loss. In 1995 radiologists in France made the observation that bilateral embolization of the uterine arteries was associated with reduction of uterine fibroid tumor volumes and overall uterine volume. More importantly, patients who underwent this procedure experienced improvement or resolution of their symptoms approximately 80-90% of the time. Since that seminal observation, the procedure of uterine fibroid embolization has grown in popularity and has been used as a definitive therapy in peri-menopausal women for relief of symptoms of fibroid tumors of the uterus in over thousands of women worldwide. The procedure holds much promise as a non-surgical alternative to hysterectomy for the treatment of symptomatic myomata of the uterus.
Transcatheter arterial embolization of the pelvic visceral arteries for the above applications (and others) is performed in the vast majority of cases using a right common femoral arterial puncture site. The most common anatomy is that the arteries supplying the pelvic viscera arise from the anterior divisions of the internal iliac arteries, which arise from the common iliac arteries. In clinical practice, the arteries most commonly embolized are from the anterior division of the internal iliac artery. When performing catheterization of these pelvic visceral arteries via a right common femoral approach, it is usually technically easier to place the catheter into the contralateral visceral arteries than the ipsilateral visceral arteries due to the angle at which the vessels arise from the contralateral internal iliac artery. Traditionally it has been necessary to utilize several different catheters of varying shapes, lengths and materials to accomplish the catheterization of the bilateral pelvic visceral arteries prior to embolizing them and thus completing the procedure. Every catheter exchange increases the length and difficulty of the procedure. The risk of any interventional radiological procedure is directly proportional to its overall duration in time.
Every exchange increases the likelihood of vessel damage or non-target embolization.